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Thank you for your question.
We encourage you to check the reference of the charts on the ultrasound machine(s) in your department and source the original paper to find out how the BPD should be measured according to the charts being used.
Across Australia there is a large range of charts being used. Hadlock is quite common for EFW. Chitty is another chart often referenced.
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Thank you for your question.
An ASA guideline is currently being prepared on this topic.
Existing recommendations are to perform a transvaginal examination when requested for high risk patients or when transabdominal imaging demonstrates a shortened cervix.
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Hello Colleague,
In my department we follow the attached ASUM-ACIPC guidelines for infection control (attached).
If the patient's scrotal skin is intact, on scan completion we wipe the probe with a TB Oxivir wipe (as we do with all examinations) only.
We only high level disinfect the probe if the scrotal skin is broken, or the probe comes directly in contact with bodily fluids.
Hope this helps,
Marilyn Zelesco
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Thank you for your question.
This can be quite specific to patient condition post partum. Ie; stitches, caesarean section, etc. and may depend on patient consent or direction from the referrer.
However, typically 28 days post partum is considered acceptable for a transvaginal ultrasound.
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Hi Jackie,
Thank you for your suggestion. We will pass this along to the Education Advisory Committee.
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Thank you for your question.
Most growth scans are plotted on a generalized population chart, and in this instance the referring midwife or physician would need to plot fetal growth on a customized chart and proceed on patient follow up and care based on that.
Below is an example of what could be stated on the sonographer impression sheet:
Growth measurements in this report are plotted on population based growth charts. It is recommended that EFW be plotted on a customised chart (eg. GROW). If the EFW is below the 10th centile on the customised chart, please refer for urgent Doppler assessment.
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Thank you for your question.
Current recommendations are for the NT to be performed between 11-14 weeks (45-84mm), with 3.5mm and above considered abnormal. The nuchal fold measurement is to be performed at the routine anatomy scan from 18-22 weeks. Typically less than 6mm is considered normal at the anatomy scan.
Limited literature exists regarding the nuchal fold measurement between 14-18 weeks. A local Obstetrician may be able to provide guidance if they are requesting this.
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Thank you for our first ask an expert question! It's a good one.
For renal arteries (and any artery really for that matter) you ideally want to maintain a consistent Doppler angle as close to 60degrees as possible. It's my understanding that the flow velocities published in the literature are based on Doppler angles corrected to 60degrees. For grading proximal renal artery stenosis I prefer using renal-aortic-ratio (RAR) which is renal artery stenosis velocity divided by aortic velocity at renal level.
It can be hard with abdominal vascular scans to maintain an angle of 60 because you can't steer the beam so you need to heel and toe the probe to the best of your ability to create this angle. In the event you simply can't achieve an angle of 60, and don't I necessarily advocate for this, then angles of 45-60 have been shown to produce results with acceptable degrees of error. It goes without saying though that if you interrogate a renal artery stenosis with an angle of say, 48degrees then you must use the same angle in the aorta to produce a reliable RAR. General rule of thumb is that an RAR of >3.5 equates to a >60% stenosis.
For intra-renal arteries we don't correct Doppler angle (angle of 0degrees) at the lab I work at because we only measure resistive indices at the upper, mid and lower poles.
I'm sure the other vascular SIG members will be able to provide supplementary information - hope this helps!
Matt
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Hi Sally,
I am assuming this is for a foetal scan?
Ta
Anthony
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Dear Karen,
thanks for your question.
I have attached the consent form we use at FSH for your perusal - you are welcome to use it.
We ask the patient if they have a known PFO and dont use it in these cases, although it is used in echocardiography successfully in these patients. Our main contraindications is we dont use it in pregnant or lactating patients, and we have not used it in any minors.
We have used it in renal transplant cases with no known adverse outcomes.
For renal cases we use one vial for up to 3 injections - that equates to around 0.4mL per case with a saline flush of around 3-4 mL as a chaser.
Hope this answers your question. Please feel free to post again if required.
Thanks Marilyn (on behalf of the Abdo SIG group).
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The ASA doesn’t have a policy or guidelines on Pediatric hips as protocols via from state to state . With regard to the FHC, again it varies state to state with those who only use FHC ( ie common in NSW) relying on over 58% as normal .Where those that use a combination of technique Grafs, Harkes and Morins, tend to use over 50 % as being equivalent to Graf 2a which is undeveloped rather than true dysplasia and 58% as normal. The important thing is to use established evidence based criteria and to ensure the measurements are applied correctly. Also focus should be on obtaining the correct image with the correct landmarks.
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After discussing with the committee , no formal recommendations for transducer cleaning with HLD devices has been made. General decontamination techniques , such as Clinell wipes is satisfactory.
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Thank you for your post.
Having a document, or multiple documents, regarding consent for transvaginal examinations would be a requirement of the practice/clinic/hospital to develop based on existing policies that may differ from site to site. It may be important to ensure that not just a consent form is translated into the required language, but a question/answer section as well.
Many centres have translation services available, or may require the patient to arrange for a translator.
One option is to use google translate, as smart phones and computers are more readily available.
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Thank you for your question.
This may be something to discuss with your Radiologists/Obstetrician/Charge Sonographer to determine the preference for your worksite.
The follow charts could be considered:
https://fetalmedicine.org/research/doppler
file:///C:/Users/QKPUser/Downloads/NZMFMN%20Obstetric%20Doppler%20Guideline%202015%20(11).pdf
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Hello and thank you for your question.
This is a question that may be better directed to the Sonographer and Wellbeing SIG.
However there are guidelines (ASA and ASUM joint Guidelines for Reducing Injuries to all Ultrasound Users) that do state that repetitive scans should be avoided.
A discussion with your management and/or booking staff may be needed as well.
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Thank you for your question.
As this is a relatively new situation we as sonographers, Obstetricians and medical professionals across the board are facing, there is still a lot of uncertainty.
At this point, our recommendations would be to treat these scans as we do all growth scans and comment on any findings.
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Thank you for your question.
Nuchal cord typically isn't recommended to screen for, as fetal position can change and alter whether a nuchal cord is present or not.
The article below has some useful suggestions for examining the fetus for nuchal cord.
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Thank you for your question.
This can be seen in cases of persistent right umbilical vein (PRUV).The PRUV connects to the right portal vein and curves towards the stomach. Normally the right umbilical vein regresses but when it persists, it can be a normal variant and isolated or associated with cases of heterotaxy and situs inversus. If detected, you may see a 4 vessel cord and it is important to ensure you perform a detailed assessment of the heart and check the relationship of the aorta/IVC in the abdomen.
Disclaimer: by using this service you recognise that the information provided is general in nature; it does not constitute professional advice. Any views expressed are those of individual(s) and may not reflect ASA’s views. The ASA does not endorse any product or service identified. You use any information provided at your sole risk and the ASA is not responsible for any errors or for any consequences arising from that use.
Hello, thanks for your question. This SIG deals with paeds and adults, not foetal. I would suggest you redirect your question to the Woman's Health SIG.
Thanks
Anthony